Dubai: Periodic screening, due awareness, a systematic treatment regime and vaccinations can help prevent the spread of viral hepatitis, doctors in the UAE have alerted ahead of World Hepatitis Day on July 28.
Currently, over 300 million people worldwide are living with different forms of hepatitis such as chronic Hepatitis B (HCB) and Hepatitis C (HCV). In the UAE, studies indicate nearly 0.24 per cent of the national population and 1.6 per cent of the expatriate population suffer from Hepatitis C, while the prevalence of Hepatitis B is 1.0-1.5 per cent. The condition can be serious and life-threatening as it causes liver damage, liver cirrhosis (scarring) and liver cancer with a requirement for a liver transplant.
Ayman Elsayes, director of Medical Affairs for Gilead Sciences, Middle East, who has reviewed some of the potent threats from the viral infection, spoke to Gulf News on what the infection is about, its prevalence and how it can be best dealt with.
Which of the hepatitis strains are more prevalent in the UAE and why? If you could take us through the A, B, C strains and their respective levels of danger to the community?
Infection caused by either HCV or HBV, if untreated, could lead to long-term and serious complications. HBV is more prevalent among Emiratis while HCV more common among expatriates.
What is the position of UAE vis-a-vis the world in terms of the incidence and prevalence of hepatitis infections?
Based on expert input, the incidence of hepatitis infections in the UAE is lower than other countries. For example, according to a modelling study, the global prevalence of HBV was 3·9 per cent with the UAE at 1·0 per cent. Within HCV, the prevalence is 1.64 per cent in UAE against a total global HCV prevalence estimated at 2.5 per cent.
Who is at high risk of exposure in the community?
Certain subpopulations are at an increased risk, especially those who work in health services that requires handling of bodily fluids, HIV patients, diabetics, those who practice unsafe sex and those who do not follow sterile hygiene practices.
What is the long-term damage?
Left untreated, hepatitis could lead to liver cirrhosis, liver failure and hepatocellular carcinoma.
Is there no cure for hepatitis?
HCV is curable, with recently introduced therapies that involve a short treatment duration of up to 12 weeks. The treatment is very effective with a response of 95-99 per cent. As of now, there is no cure for HBV. However, treatment, which could suppress the HBV viral replication and prevent complication, is also available and should be used lifelong. Gilead is working extensively on potential molecules and treatment that could result in a cure within the next five years.
• Focus on primary care physician education. This is an important step, as awareness will support the UAE’s tremendous efforts and commitment to eliminate hepatitis as per WHO guidelines.
• Periodic screening for HCV in persons are in the risk groups. After a person exposed to HCV becomes infected, virus particles can be detected within 1-2 weeks. Liver function tests also tend to rise during this time frame.
• After a positive diagnosis, it is important to speak to a liver specialist and to start medication, finishing the course, with follow up meeting with the specialist and repeating treatment until cleared or negative.
What are the symptoms?
Viral hepatitis is asymptomatic; even in the most acute cases it presents flu-like symptoms. Chronic HBV can produce no symptoms in its earlier stages, meaning many individuals are unaware that they have contracted the infection until they have advanced liver disease. Within HBV, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. A small subset of persons with acute hepatitis can develop acute liver failure, which can lead to death. Chronic HBV infection can persist for years without causing any noticeable symptoms. Many people are unaware they are infected and do not seek treatment. Potentially fatal liver disease can be caused by HBV, which is more easily transmitted than HIV.
Which section of the population is most vulnerable to HPV infections?
HBV is contagious and can be spread through direct contact with infected blood, blood products or other bodily fluids. Complications commonly associated with chronic HBV include scarring of the liver (cirrhosis), liver failure and liver cancer. HBV can be transmitted by any activity that involves exposure to blood and other body fluids, including sexual contact and use of contaminated needles during injection drug use. It can also be transmitted from mother to child at birth. Occupational exposure to blood and other body fluids is among other modes of transmission.
What is the prognosis once you contract the infection?
While most new cases of HBV infection in previously healthy adults are cleared by the immune system within a few months, many people — especially those infected as newborns and young children — will develop chronic, lifelong infections. In these cases, chronic HBV can slowly destroy the liver, causing scarring (cirrhosis), liver disease, or liver cancer over many years or decades. Because it is believed to be the cause of 80 per cent of all liver cancer cases worldwide, HBV is second only to tobacco among known human carcinogens. Although there is no simple cure for chronic hepatitis B, antiviral treatment can slow viral replication and therefore reduce liver inflammation and liver injury.
HCV remains one of the leading causes of preventable death globally. HCV can be transmitted through perinatal transmission, haemodialysis, blood transfusions, unsafe sterile practices, for example, at dental clinics, tattoo parlours. Public health experts now believe that it is possible to eliminate the disease through targeted treatment, with HCV elimination programmes having a tremendous impact on global health, averting mortality from HCV-related complications each year. Currently, no vaccine exists for HCV and, until recently, treatment could take six to 12 months, often with debilitating side effects and low cure rates.
How can one avoid HPV?
The general population can drastically reduce risk of infection by adhering to safe hygiene and clinical practices, further to avoiding risky behaviours, such as sharing needles, having unprotected sex and drinking large amounts of alcohol. Vaccines are available for HBV.
Is vaccination the best way to prevent hepatitis?
Vaccination is mandatory for HBV in the UAE, especially within certain professions. That had led to significant decrease in incidence and prevalence. However, currently, there are no vaccines available against HCV.
What else is Gilead offering to combat hepatitis in the UAE?
Gilead is actively supporting the World Health Organisation’s (WHO’s) worldwide efforts to eliminate HCV by 2030. Since 2013, more than 1.7 million people living with HCV in low- and middle-income countries have been treated with Gilead HCV regimens. For more than two decades, Gilead has worked to improve care for people living with chronic HBV. While a vaccine exists for HBV, developing a cure is a more complex challenge than it is for HCV. Such a cure will need to combine multiple drugs that inhibit viral replication while simultaneously eliminating HBV DNA from all infected liver cells.
In the UAE, beyond just treatment, Gilead is supporting medical education workshops directed mainly for primary care physicians and nurses. As part of these efforts, Gilead has initiated the “MA’AK” Patient Assistance Programme, which aims to support access to Gilead HCV medicines for patients facing affordability barriers. The MA’AK programme complements efforts by authorities to eliminate HCV, by enabling patients to access and complete their full course of treatment.
Apart from vaccinations what else can be done in the prevention of hepatitis (educational campaigns, screenings etc)?
Gilead is at the forefront of advancing care for patients with liver disease, with four breakthrough treatments for HCV. Similarly, we are developing innovative treatments to manage or potentially cure chronic HBV infection. In addition, we seek to remove barriers to testing and treatment for at-risk individuals and expand access to our therapies. We are working toward this target by actively supporting the efforts of governments, patient organisations, payers and health care providers to increase awareness, drive screening and facilitate linkage to care.